US5258015A

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Info

Publication number: US5258015A
Application number: US07/695,536
Authority: US
Inventors: Lehmann K. Li; James P. O'Leary
Original assignee: American Cyanamid Co
Current assignee: Smith and Nephew Inc
Priority date: 1991-05-03
Filing date: 1991-05-03
Publication date: 1993-11-02
Anticipated expiration: 2011-05-03

Abstract

An improved locking cap for mounting on the smooth flexible filament of a surgical fastener wherein the locking cap is of a thin flat washer-like shape with gripping elements for engaging the filament and locking the cap in position relative to the filament.

Description

FIELD OF THE INVENTION

This invention relates to surgical fasteners used to attach two or more tissue members to one another, or a tissue member to a bone, and is more particularly concerned with a means for locking the fastener end elements against the tissue.

BACKGROUND OF THE INVENTION

Surgical fasteners are used to attach two or more tissue members to one another. A typical fastener consists of a relatively thin flexible filament having a relatively rigid, bar-like head on at least one end thereof, wherein the bar-like head normally resides perpendicular to the adjoining length of filament during use. In U.S. Pat. No. 4,669,473, issued on Jun. 2, 1987 to Richards et al., there is shown such a surgical fastener, generally referred to as a "T-bar" type of fastener. The fastener is deployed, for example, by anchoring the fastener's bar-like head in a human bone by means of a special tool, with the filament threaded through the tissues to be joined. The several tissue members may then be captivated on the filament between the fastener head and the end of the filament by tying a knot on the free end of the filament. In U.S. Pat. No. 4,669,473 there is shown a filament which has a plurality of ribs formed along its filament of conical shape, with the large end of each cone closer to the head. An associated washer is slid over the free end of the filament in the direction of the head end and brought to bear against the outermost tissue to be joined. The washer cannot move backwards away from the head end because of the conical nature of the ribs. A related concept is shown in U.S. Pat. No. 4,532,926, issued on Aug. 6, 1985 to O'Holla. Such an arrangement has proven to be costly and disadvantageous in that the body of the filament is required to be specially formed with conical elements. Further, since it may be desired to provide a certain degree of tension between the tissue members or the tissue members and bone, the stepped arrangement provided by the ribbed filament affords only a rudimentary degree of tensioning in predefined incremental amounts. Additionally, slight loosening may occur when the washer is set by the appropriate tool, since there is a tendency for the washer to slip backward to the next outboard conical rib when the washer is set.

Another form of tissue fastener arrangement is shown in European Patent Application Publication No. 0,129,442, published On Dec. 27, 1984, in which a staple type fastener has its legs brought through a bar member and wherein the legs are subsequently permanently deformed or coined to form a bulged out portion within the bar member, not unlike a "pop" rivet. Such a construction requires that metal or other material be used which has no memory, i.e., which can be deformed and which thereafter will not return to its former position. This requirement limits the use of such a construction to special materials which will retain this deformation when a special "setting" tool is removed after the staple is in place. Most materials used in fasteners which are intended to be absorbed by the human body would therefore not be capable of use in this type of staple.

OBJECTS OF THE INVENTION

It is therefore one object of the invention to provide a locking filament cap that may be used with a smooth strand filament of a surgical fastener, and which is locked into position by a clamping action at any point along the filament.

It is a further object of the invention to provide alternative arrangements of filament caps which may be slid along the smooth surface of a filament until reaching the desired point of placement, whereupon portions of the caps are caused to lock to the smooth filament of the suture.

A still further object of the invention is to provide a locking cap for a suture having filament ends which is universal in nature, in that it may be deployed with sutures of various forms which have straight filament ends.

Still another object of the invention is to provide a locking filament cap that is usable with a smooth strand filament surgical fastener, and can retain any desired degree of tensioning between tissue members or between tissue members and bone.

SUMMARY OF THE INVENTION

In accordance with the present invention there is provided a fastener cap which is deployed along the smooth filament of a surgical fastener. The fastener cap may be in one of several forms which provide gripping elements to bear against the filament and which are urged into filament-engaging position, at which time the filament end may be cut flush with the end of the cap. Among the forms of filament caps are those provided with locking flaps attached by living hinges to the cap. In another form a floating rod is used which lies within an angled passage within the cap and which can assume a pinching and gripping position when tension is applied to the filament and subsequently released. In still another form a wedging sleeve is employed which may be placed into anchored position within the cap whereby it bears against the filament to grip it, and is incapable of being withdrawn. An alternate form of such a cap employs a collet having wedging fingers which are caused to grip the filament when an appropriately shaped washer is pushed over the collet. In a further form of the invention a gripping bar or gate is pressed into position into an appropriately shaped recess in the cap and frictionally retained therein as a result of the tension applied to the filament. A method of applying the locking filament cap is also described.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects of the invention are described in more detail hereinafter, and are further illustrated in the accompanying drawings, in which:

FIG. 1 is a perspective view, partially in cross-section, of the use of a locking filament cap in connection with a "T-bar" suture in an arthroscopic surgery procedure;

FIG. 2 is a cross-sectional view taken alongline 2--2 of FIG. 3, showing one form of locking filament cap of the invention;

FIG. 3 is a top plan view of the locking filament cap shown in FIG. 2;

FIG. 4 is a perspective view of another form of locking filament cap of the invention employing living hinge-mounted clamping elements;

FIG. 5 is a cross-sectional view of still another form of locking filament cap employing a rolling locking rod;

FIG. 6 is a cross-sectional view taken alongline 6--6 of FIG. 5;

FIG. 6A is a cross-sectional view similar to FIG. 6 but showing a variation of the locking rod arrangement;

FIG. 7 is a cross-sectional view of a further form of locking filament cap according to the invention;

FIG. 8 is a perspective view of the wedging sleeve of the locking filament cap shown in FIG. 7;

FIG. 9 is a perspective view of a further embodiment of a locking filament cap of the invention shown in open position;

FIG. 10 is a cross-sectional view showing the locking filament cap of FIG. 9 in closed position; and

FIG. 11 is a perspective view of still another embodiment of the invention employing a collet-washer combination.

DETAILED DESCRIPTION OF THE INVENTION

The general conception of the application of the invention is shown in FIG. 1, wherein a "T-bar" fastener 1 has its headed end 4 embedded in abone 2. Extending from the headed end 4 is asmooth filament 6 which passes through thetissue 8 and extends therefrom generally perpendicular to the headed end 4. Thelocking filament cap 10 has thefilament 6 passing through it and anactuator tool 12 is employed which pushes thecap 10 from an initial position (shown in dotted lines) along the filament until it rests against thetissue 8. Tension is then applied to thefilament 6 by simply pulling on it in the direction of the arrow. When the appropriate degree of tension is applied theactuator tool 12 is operated to actuate the locking function of thecap 10. Thereafter the filament is severed close to the cap.

By way of example, fastener 1 may be of the sort taught in U.S. Pat. No. 4,669,473, and it may be deployed using an installation tool such as one of the sort taught in that patent. The fastener 1 may be formed out of a resilient polymerized resin with thefilament 6 being thin and relatively flexible and the headed end 4 being relatively stiff in accordance with the teachings of U.S. Pat. No. 4,669,473. Where the fastener is to be made absorbable by the body, it may be formed out of a polylactide copolymer or a glycolide copolymer in accordance with the teachings of U.S. Pat. Nos. 3,636,956 and 4,300,565. Where the fastener is to be non-absorbable by the body, it may be formed out of a suitable nylon or polyethylene or carbonate polymer or polyether ester copolymer in accordance with the teachings of U.S. Pat. Nos. 4,300,565 and 4,314,561. As an illustration of the size of the suture in atypical application filament 6 will have a diameter of 0.015 inches and the headed end 4 will have a diameter of 0.030 inches and a length of 0.180 inches. The filament locking cap must be made of a material that is denser than the suture filament material in order to be able to deform it and lock the cap against movement. In many applications the cap may be formed of the same material as the headed end 4.

Alternatively, fastener 1 could be a different sort of fastener, so long as the fastener includes a smooth filament element to which thecap 10 must be affixed.

In one embodiment of the invention shown in FIGS. 2 and 3 afilament locking cap 22 is shown having a washer-like configuration which employs a "living hinge" construction. Thecap 22 is mounted upon asmooth filament 20 of a fastener, wherein the filament will be tensioned by pulling on it in the direction of the arrow shown in FIG. 2. The lockingcap 22 is formed with a generally cylindrical shapedbase sector 24 provided with a centrally locatedhole 25 of a diameter which permits passage of thefilament 20 with a snug fit. The cap has a recessedarea 44 of a shape as shown in FIG. 3 formed to enable a pair of locking

flaps

30 and 32 to move therewithin. Extending upwardly from thebase sector 24 are first and second

arm sector portions

28 and 26, respectively. First lockingflap 30 extends from thefirst arm sector 28, and thesecond locking flap 32 extends from thesecond arm sector 26. The

arm sectors

28 and 26 are joined to the locking flaps 30 and 32 respectively by respective living hinges 40 and 38. The livinghinge 38 is formed by a recessedarea 37 at its lower surface and a recessedarea 39 at its upper surface. Similarly, the livinghinge 40 is formed by a recessedarea 41 at its lower surface and a recessedarea 43 at its upper surface.

The lockingflap 30 is provided with a series ofteeth 36 at its innermost extremity and the lockingflap 32 is provided with a series ofteeth 34 at its innermost extremity. Lockingflap 30 is further provided with astabilizer bar portion 46 extending in opposed directions therefrom as shown in FIG. 3, and lockingflap 32 is also provided with a stabilizer in the form ofbar portion 48 extending in opposed directions away fromflap 32.

When the headed end of the fastener is implanted in bone or body tissue and thefilament 20 is drawn through the tissue and extended outwardly from the body, the lockingcap 22 is placed on the filament and moved therealong until it contacts the outermost body tissue. The filament is then grasped and placed in tension by pulling it in the direction of the arrow shown in FIG. 2 while an appropriate fastening tool pushes the locking cap firmly against the body tissue. A series offoot members 42 protrude from the lower surface ofbase sector 24. When the locking cap contacts the body tissue thefoot members 42 are pressed into the body tissue to anchor the locking cap against rotation about the filament. The tool then depresses the locking flaps 30 and 32 inwardly so that the series of

teeth

34 and 36 are pressed into engagement with the filament 20 (shown in a somewhat exaggerated position in FIG. 2). Upon release of the filament end, the filament, being somewhat resilient, will want to return to its former position. This will apply continuing compressive forces to the

flaps

30 and 32 to keep them in the position shown in FIG. 2. Alternatively, even if the filament is not itself somewhat resilient, the tissue engaged bycap 22, having been compressed by the cap and generally being itself somewhat resilient, will cause

flaps

30 and 32 to apply continuing compressive forces tofilament 6. The stabilizer bars 46 and 48 serve to prevent any cocking of the respective flaps so that the respective series of

teeth

36 and 34 are maintained in the most appropriate configuration for engagement with thefilament 20.

Another form of lockingcap 52 is shown in FIG. 4. Thecap 52 is shown as being mounted for use with thefilament 50 wherein the filament will be tensioned by pulling on it in the direction of the arrow shown in FIG. 4. In this embodiment thecap 52 is provided with acentral hole 51 dimensioned so as to receive thefilament 50. Thecap 52 is provided with abase sector 54. First and second locking flaps 56 and 58 are hingedly connected to thebase sector 54 of thecap 52. These flaps are identical in construction, and only one of them is described in detail hereafter. As shown in FIG. 4, the lockingflap 56 is connected to thebase sector 54 by means of a livinghinge 60 constructed in a manner similar to the living hinges 38 and 40 of the embodiment of FIGS. 2 and 3. However, the lockingflap 56 is formed of twoarm sectors 64 and 66, which are joined together by asecond living hinge 62. Thearm sector 66 is longer in extent than sector 64. On theoutermost surface 73 of thesector 66 there is provided a V-shaped recess or notch 68. The recess is tapered so that on one surface 67 of thesector 66 the edges of the recess are further apart than the cut out portion on the surface opposite to surface 67 of the sector.Sector 66 is provided with opposed first and

second arm extensions

70 and 72, respectively, for a purpose which will become apparent hereafter.

A series of

upstanding posts

74, 76, 78 and 80 are provided which protrude from thebase sector 54. The surface 82 of the lockingcap 52 has anarea 84 lying between the

posts

78 and 80, and anarea 86 lying between the

posts

74 and 76. A series offoot members 88 are provided on the lower surface of thebase sector 54 for grasping the tissue surface so as to prevent rotation of the lockingcap 52 about thefilament 50.

When the lockingcap 52 is placed on thefilament 50 and pushed along it until it seats on body tissue, the locking flaps 56 and 58 are folded on their first living hinges (such as 60 of flap 56) in a manner so that the first arm sectors (such as sector 64 of flap 56) are placed between their adjacent posts (e.g. posts 74 and 80 for flap 56) in a position generally perpendicular to surface 82. The second living hinges of the flaps (such as 62 of flap 56) are thus positioned at a level coordinate with the upper surface of the

posts

74, 76, 78 and 80. When the filament is placed in tension by pulling it in the direction of the arrow in FIG. 4, the second arm sectors (such as 66 of flap 56) are then folded over on the second living hinge (such as 62 of flap 56) so that the recesses on the locking flaps (such as 68 on the surface 73) will encompass thefilament 50. As shown in FIG. 4 the taper formed by the V-shaped recesses is such that a smaller opening is presented at a level above a larger opening with respect to surface 82 when the

flaps

58 and 66 are in the seated position. Thesurface 73 is also tapered at an inclined angle as shown in FIG. 4 so that theedge 75 offlap 56 is in contact with itscomplementary edge 77 onflap 58 when the flaps are in clamping position. When the

flaps

56 and 58 are pushed downwardly by an appropriate setting tool and the tension which was placed onfilament 50 is released, the filament will exert compressive forces on the

flaps

56 and 58 to cause the smaller diameter of the tapered recesses to more tightly grip the filament and retain the cap in locked position relative to the filament.

Alternatively, the second hinges (such ashinge 62 of flap 56) may be omitted, and in such event the V-shaped tapered recesses would be formed so that a smaller opening will be presented at a level below a larger opening, with respect to surface 82 when the

flaps

58 and 66 are in their seated positions. Should thefilament 50 relax and reach a stage where compressive forces on the flaps are reduced to a point that the flaps will have a tendency to rise upwardly away from surface 82, because of the tapered recess arranged as just described, the flaps will be urged to grasp the filament more firmly at the smaller diameter of the tapered recess.

A further embodiment of a locking filament cap is shown in FIGS. 5 and 6, to be used in connection with afilament 90 wherein the filament will be tensioned by pulling it in the direction of the arrow shown in FIG. 5. The lockingcap 92 is formed of upper and

lower members

94 and 96, respectively, which are bonded together. Aligned

central holes

98 and 100 are provided in

cap members

94 and 96, respectively, and serve to allow passage of thefilament 90. Aslot 104 is formed within the

cap members

94 and 96 to accommodate a lockingrod 102. The slot is internal of the assembledcap 92, and therod 102 is captured within it to move within theslot 104. When the cap is placed on the filament and moved downwardly therealong as viewed in FIG. 5, therod 102 will ride up the inclined surface ofslot 104 to theuppermost position 101 shown in dotted lines. When tension is applied to filament 90 (by pulling it in the direction of the arrow in FIG. 5) and it is released after thecap 92 is placed into position, the forces applied by the filament will cause therod 102 to assume the position shown by solid lines in FIG. 5, with the rod bearing against thefilament 90. A limit of travel ofrod 102 is assured by thelower lip 106 formed by theslot 104.

As shown in FIG. 6slot 104 is not coterminus with the periphery of lockingcap 92, but instead terminates short thereof atend walls 105 and 107. The length ofslot 104 is approximately the same as the length ofrod 102, but is dimensioned so as to permitrod 102 to freely roll therewithin.

Alternatively, the slot may extend to the periphery of the cap, in which case the rod may be longer than the slot. As shown in FIG. 6A, the slot 111 extends to the periphery of lockingcap 93 and therod 103 extends beyond thecap 93, terminating in

end portions

108 and 109. When thecap 93 is set at the desired position against a layer of tissue and the filament is placed under the desired degree of tension, the cap can be locked in place by grasping the

end portions

108 and 109 and manually forcing therod 103 downwardly in slot 111.

A further embodiment of a locking cap is shown in FIGS. 7 and 8 wherein a wedgingsleeve 114 is employed in connection with a lockingfilament cap 112. Thecap 112 is formed in a generally washer-like configuration as seen in FIG. 7 and is provided with a centrally located tapered hole 118 shaped to receive the similarly tapered wedgingsleeve 114. The wedging sleeve comprises awedge body 120 which is cylindrically shaped at itsupper part 121 and conically shaped at itslower part 123. Thebody part 123 is provided with acentral hole 122 of a diameter enabling passage of thefilament 110, wherein the filament will be tensioned by pulling it in the direction of the arrow shown in FIG. 7. Thehole 122 extends from aninitial recess 124 of larger diameter in theupper body part 121. Therecess 124 is of a size which is adapted to receive anactuator tool 116. At the bottom of therecess 124 there is formed alanding area 134, against which thetool 116 is brought to bear. A series of

slots

125, 127 and 129 are formed in the lower taperedconical section 123 of thebody 120 which divide it into wedging

flaps

126, 128 and 130. A series ofinterlock tabs 132 are provided, one at the lower end of each of the wedging flaps to prevent thesleeve 114 from backing out of thecap 112 once the sleeve is assembled to the cap.

In use thelocking cap 112 is placed on thefilament 110, and thesleeve 114 is assembled to it but not pushed downward into locking position. The thus loosely assembledcap 112 is pushed along the filament (which has been tensioned by pulling it in the direction of the arrow shown in FIG. 7) until it reaches the tissue surface. Further pressure by thetool 116 will cause thecap 112 to be locked in place on the filament, since pressure onsleeve 114 moves it further into the tapered hole 118 to in turn increase the pressure on the wedging flaps to push them into contact more firmly with thefilament 110, and to allow the interlocking tabs to be seated.

Another embodiment of the teaching of the invention is shown in FIGS. 9 and 10. Thefilament cap 142 is of cylindrical shape and has a throughhole 141 to accommodate thefilament 140, wherein the filament will be tensioned by pulling it in the direction of the arrow shown in FIG. 10. Thebody 144 of thecap 142 has a portion removed to provide a recessedarea 152. A lockingflap 146 is formed integrally with thebody 144 and attached thereto by

arms

148 and 150. Theouter surface 147 offlap 146 is preferably formed in a curved shape to cooperate with a similarly shapedsurface 153 in the recessedarea 152 of the cap to permit thelocking flap 146 to be retained in locked position. A lower recessedportion 154 is provided in thearea 152 to accommodate a setting tool for moving and locking theflap 146. When thecap 142 is moved along thefilament 140 and against the tissue, the flap is positioned into the opening ofrecess 152. The setting tool is then used to seat the flap into locked position wherein the

surfaces

147 and 153 are in mating position, or as nearly so as possible. Thenotch 156 on theinner surface 158 offlap 146 is of V-shape so as to provide a gripping arrangement for thefilament 140 when cooperating with the surface which defines the walls forming thehole 141. Thesurface 158 is tapered to provide a leading edge 159.

A still further embodiment of the invention is shown in FIG. 11. The lockingcap 161 comprises two elements, a collet 166 and awasher 162. The collet 166 is provided with acentral hole 167 to permit the passage of thefilament 160, wherein the filament will be tensioned by pulling it in the direction of the arrow shown in FIG. 11. The collet is of generally flat cylindrical shape and is provided with alocking extension 168. The extension is furcated to form a series of locking flaps 170 (four being a convenient arrangement). Eachflap 170 has a taperedsurface 171 which leads to atab 172 extending normal to theflap 170. Eachtab 172 has aninner surface 173 against which thewasher 162 may bear. Thewasher 162 has opposed

surfaces

174 and 176 and a centraltapered hole 164. Thewasher 162 is assembled to the collet by being forced over thetabs 172 so that thewasher surface 174 rests against thesurface 173 of thetabs 172. In use, the separated collet 166 andwasher 162 are placed on thefilament 160, the filament is tensioned by pulling it in the direction of the arrow shown in FIG. 11, and then the collet is moved toward the tissue, with thecollet surface 179 being placed against the tissue. In order to lock thecap 161 to thefilament 160, thewasher 162 is moved into engagement with the collet so that thesurface 176 ofwasher 162 approaches thesurface 178 of the collet. This causes flaps 170 to engagefilament 160 and thereby hold the cap in place along the filament, withtabs 172 preventing the washer from separating from the collet.

Although what have been described are preferred embodiments of the invention, it is to be appreciated that various modifications may be made without departing from the spirit and scope of the invention.

Claims

What is claimed is:

1. A combination of a surgical fastener having a fastener end and a locking cap means for securing the fastener end against tissue, the combination comprising:

a surgical fastener having a fastener end,

a cap body having a through passage adapted to receive said fastener end and allowing for translational movement of the cap body with respect to the fastener end,

means associated with said cap body providing at least one locking member which is movable into a clamping position wherein said member temporarily deforms said fastener end to insure positive clamping but which if moved out of the clamping position allows the fastener end to return to its non-deformed condition,

and wherein said fastener end is of such material that when tensioned and released it will exert pressure to maintain the locking member in clamping position.

2. The locking cap means of claim 1 wherein the means associated with said cap body provides at least two locking flag elements connected to said cap body by means of a living hinge.

3. The locking cap means of claim 2 wherein said locking flap elements have end portions which are arranged to lie opposed to each other adjacent said through passage.

4. The locking cap means of claim 3 wherein said end portions are each provided with a plurality of teeth.

5. The locking cap means of either of claims 3 or 4 wherein said locking flap elements are each provided with a stabilizer element extending normal to the path of motion of said flap elements.

6. The locking cap means of claim 5 wherein said cap body has a recessed area within which said flap and stabilizer elements are accommodated.

7. The locking cap means of claim 2 wherein said cap body is provided with a series of upstanding post members spaced from one another to provide recessed areas to accommodate said locking flaps.

8. The locking cap means of claim 7 wherein said locking flap elements have end portions which are arranged to lie opposed to each other adjacent said through passage.

9. The locking cap means of claim 8 wherein said end portions are provided with recessed areas juxtaposed to one another at said through passage and of a generally V-shape to accommodate said filament.

10. The locking cap means of claim 9 wherein said recessed areas on said end portions are tapered so that openings are presented on the upper and lower surfaces of the flap elements which are of different depth.

11. The locking cap means of claim 3 wherein each of said flap elements have a second living hinge located intermediate said first living hinge and the end portion.

12. The locking cap means of claim 1 wherein the means associated with said cap body comprises a locking rod movable within said cap body into a clamping position wherein a portion of the rod bears against the fastener end to deform it and insure a positive clamping action.

13. The locking cap means of claim 12 wherein said cap body is provided with a slot dimensioned so as to receive said locking rod in a rolling fit, said slot being angled to said fastener end so as to direct said rod toward the fastener end.

14. The locking cap means of claim 13 wherein said slot is internal of the cap body whereby said rod is captured within said cap body.

15. The locking cap means of claim 13 wherein said slot passes through said cap body substantially chordal to said through passage, and said rod is of a length that exceeds the length of said slot whereby portions of said rod protrude from said cap body.

16. The locking cap means of claim 1 wherein the means associated with said cap body comprises a wedging sleeve providing a plurality of wedging flaps which are movable into a clamping position with said fastener end.

17. The locking cap means of claim 16 wherein said cap body is provided with a tapered hole into which said wedging sleeve is adapted to be placed, said wedging sleeve and tapered hole being so constructed and arranged that as said sleeve is moved further into said tapered hole greater pressure is applied to said wedging flaps to urge them into clamping position.

18. The locking cap means of claim 17 wherein each of said wedging flaps is provided with interlocking means on its outer surface so constructed and arranged that when said wedging sleeve is assembled to said cap body it is prevented from backing out of the cap body.

19. The locking cap means of any of claims 16, 17 or 18 wherein said wedging sleeve comprises an upper cylindrical body having a conical lower portion depending therefrom, said conical lower portion being furcated to form said wedging flaps.

20. The locking cap means of claim 1 wherein the means associated with said cap body comprises a locking flap and a recessed area in said cap body adapted to receive said flap when it is in clamping position with respect to said fastener end.

21. The locking cap means of claim 20 wherein said locking flap is assembled to said cap body by means of attaching arms.

22. The locking cap means of either of claims 20 or 21 wherein said locking flap has an inner end surface which is adapted to bear against said fastener end, said inner end surface having an area cut out in the form of a V-notch to receive the fastener end.

23. A method for securing tissue after a surgical procedure, wherein a surgical suture is employed having a smooth flexible filament end, comprising the steps of

passing said filament end through said tissue and extending it outwardly thereof;

mounting a locking cap means upon said filament, said locking cap means having a through hole permitting said locking cap to slide along said filament;

sliding said locking cap means along said filament until said means are in contact with the tissue;

applying pressure against said locking cap means to firmly seat it against the tissue;

thereafter applying tensioning force to said filament while maintaining the pressure upon said locking cap means; and

simultaneously actuating clamping elements associated with said locking cap means into filament engaging position, whereby said filament is deformed and said clamping elements are retained in clamping position.

24. The method of claim 23 including the step of severing the filament beyond said locking cap means away from said tissue following said actuating step, whereby said filament thereafter exerts forces to retain said clamping elements in filament engaging position.

25. A locking cap means for securing the fastener end of a surgical fastener against tissue, comprising:

a cap body having a through passage adapted to receive the fastener end and allowing for translational movement of the cap body with respect to the fastener end;

means associated with said cap body providing at least one locking member which is movable into a clamping position wherein said member temporarily deforms the fastener end to insure positive clamping but which if moved out the clamping position allows the fastener end to return to its non-deformed condition;

the cap body being in the form of a collet comprising a generally flat cylindrical portion having a locking extension protruding outwardly therefrom, the through passage being located to pass through both said cylindrical portion and locking extension; and

wherein the locking extension is furcated to form a plurality of locking flaps.

26. The locking cap means of claim 25 wherein the means associated with said cap body comprises a washer-like element having a hole centrally thereof.

27. The locking cap means of claim 26 wherein the locking extension has a tapered outer surface, and the hole in said washer-like element is tapered.

28. The locking cap means of claim 25 wherein the locking extension has a tapered outer surface, and the hole in said washer-like element is tapered, whereby when said washer-like element is assembled to said locking extension with the tapered hole in said element being oriented to conform with the tapered outer surface of said locking extension, movement of the washer-like element inward along said locking extension toward the flat cylindrical portion of said collet will force said locking flaps into engagement with said fastener end.

29. The locking cap means of claim 28 wherein said locking flaps each have a protrusion at the end thereof to prevent inadvertent disassembly of said washer-like element from said collet.

30. A locking cap means for securing the fastener end of a surgical fastener against tissue, comprising:

the means associated with said cap body comprises a washer-like element having a hole centrally thereof.

31. The locking cap means of claim 30 wherein the locking extension has a tapered outer surface, and the hole in said washer-like element is tapered.

32. The locking cap means of claim 30 wherein the locking extension is furcated to form a plurality of locking flaps.

33. The locking cap means of claim 32 wherein the locking extension has a tapered outer surface, and the hole in said washer-like element is tapered, whereby when said washer-like element is assembled to said locking extension with the tapered hole in said element being oriented to conform with the tapered outer surface of said locking extension, movement of the washer-like element inward along said locking extension toward the flat cylindrical portion of said collet will force said locking flaps into engagement with said fastener end.

34. The locking cap means of claim 33 wherein said locking flaps each have a protrusion at the end thereof to prevent inadvertent disassembly of said washer-like element from said collet.

35. A combination of a surgical fastener having a smooth surface flexible filament and a locking cap means mounted on the smooth surface flexible filament for clamping against tissue, the combination comprising:

a surgical fastener having a smooth surface flexible filament;

a cap body having a hole therethrough for receiving said filament and dimensioned to permit translational movement of the cap body with respect to the filament;

means associated with said cap body providing at least one locking member which is movable into a clamping position wherein said member temporarily deforms said filament to insure positive clamping but which if moved out of the clamping position allows the filament to return to its non-deformed condition; and

said filament being of such material that when it is tensioned and released it will exert pressure to maintain the locking member in clamping position.

36. A combination of a surgical fastener having a fastener end and a locking cap means for securing the fastener end against tissue, the combination comprising:

a surgical fastener having a fastener end;

a cap body having a through passage adapted to receive said fastener end and dimensioned to permit translational movement of the cap body with respect to the fastener end;

means associated with said cap body providing at least one locking member which is movable into a clamping position wherein said member temporarily deforms said fastener end to insure positive clamping but which if moved out of the clamping position allows the fastener end to return to its non-deformed condition, said locking member being formed of a material denser than the material of said fastener end; and

said fastener end being of such material that when it is tensioned and released it will exert pressure to maintain the locking member in clamping position.

37. A combination of a surgical filament having a filament end and a locking cap for securing the filament end against tissue, the combination comprising:

a surgical filament having a filament end;

a locking cap having a first body and a second body, said first body having a first through passage adapted to receive the filament end to allow translational movement of said first body with respect to the filament end, said first body having at least two locking members mounted proximate said through passage and movable into a clamping position to engage the filament end; and

said second body having a second, larger-width through passage slideable over an outer portion of said locking member to force it into said clamping position.

38. The locking cap of claim 37 wherein one of an outer surface of said locking member and the second passage of said second body is tapered to drive said locking member into said clamping position.

39. The locking cap of claim 37 wherein said locking member includes tab means for engaging said second body to secure said second body relative to said first body.

40. A locking cap means for securing the fastener end of a surgical fastener against tissue, comprising:

a first body having a first through passage adapted to receive the fastener end to allow translational movement of said first body with respect to the fastener end, said first body having at least tow locking members spaced about a portion of said through passage and movable into a clamping position to engage the fastener end;

a second body having a second, larger-width through passage slideable over an outer portion of said locking members to force them into said clamping position;

at least one of an outer surface of said locking members and the second passage of said second body being tapered to drive all of said locking members into said clamping position; and

at least one of said clamping members including tab means for engaging said second body to secure said second body relative to said first body.